Provider Demographics
NPI:1912172149
Name:KANWAR, PUSHPJEET SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:PUSHPJEET
Middle Name:SINGH
Last Name:KANWAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-2103
Mailing Address - Country:US
Mailing Address - Phone:904-259-3151
Mailing Address - Fax:
Practice Address - Street 1:159 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-2103
Practice Address - Country:US
Practice Address - Phone:904-259-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0083533207RG0100X
FLME149153207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP01087669OtherRAILROAD MEDICARE
WA0296703OtherLABOR AND INDUSTRY
WAG8922144Medicare PIN
WA8910341Medicare PIN